- Date : 25/07/2020
- Read: 5 mins
Do you believe in the power of alternative medicine? Read on to know about AYUSH benefit in health insurance.
Most top insurance companies in India today provide coverage for AYUSH treatment after the Insurance Regulatory and Development Authority of India (IRDAI) asked them to do so in 2013. AYUSH is an acronym for six alternative systems of medicine practised in India – Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy.
If you’re convinced that any of these AYUSH treatments works for you, do check whether the health insurance plan you are thinking of buying offers coverage for that therapy or not.
The move to include alternative medical treatments in health insurance is the result of a series of developments at the government level since 1995. That year, a Department of Indian System of Medicine and Homoeopathy (ISM&H) was set up to mainstream traditional (alternative) medicine. This was the direct fallout of a growing awareness about traditional Indian medicine among the masses.
This department was renamed the Department of AYUSH in 2003. The idea was to establish a more refined version of the earlier thought process: combining alternative medicine – or rather, the constituents of AYUSH – with modern medicine and make newer medical treatments more effective, especially for treating non-communicable diseases.
The government institutionalised alternative medicine further when it upgraded the department to a separate ministry in 2014, which oversees institutes and research councils related to AYUSH. Today, more than 50 hospitals across India are accredited to provide AYUSH treatment. Quality standards for these hospitals have been laid down by the National Accreditation Board for Hospitals and healthcare providers (NABH).
Advantages of AYUSH treatment
Many people have been found to respond better to AYUSH than allopathic or newer forms of treatment, especially when it comes to non-communicable diseases; this is its biggest advantage. What’s more, AYUSH treatments are cheaper, and therefore more affordable for a larger number of Indians.
Extent of coverage for AYUSH treatment
The extent of coverage you can get on your health plan for AYUSH treatment depends on the insurer. Some plans cover only Ayurvedic treatment while others cover a mix, and there are others that still haven’t included this benefit. It is therefore advisable that you compare individual or family floater plans for AYUSH coverage.
These plans come with a cap on the amount covered, usually ranging from 7.5% to 25% of the sum insured. Some insurers fix a standard amount as a sublimit. Often, policyholders must fulfil certain conditions to claim AYUSH benefits, so it is advisable to understand these in detail before making a claim.
Premiums may vary depending upon factors such as age, location, and the prevailing taxes/GST. Notably, GST of 18% is applicable for all financial services with effect from 1 July 2017. Some insurers may charge 5% to 10% higher premium than usual under the standard health plan. Then again, some plans include a compulsory co-payment clause, where part of the admissible claim amount has to be borne by the customer.
As with routine health plans, the policyholder must stay in hospital for 24 hours to claim AYUSH benefits. Please note that one can’t simultaneously make claims for both AYUSH and allopathic treatments.
Leading AYUSH insurers
Listed below are some of the leading health insurers and an outline of their AYUSH plans:
- Cholamandalam MS
Plan name(s): (a) Individual Healthline Plan; (b) Chola Healthline Plan
Coverage scope: (a) Coverage up to 7.5% of sum insured for Ayurvedic treatment along with a 20% co-payment clause; (b) coverage for AYUSH treatment
- HDFC Ergo
Plan name: Health Suraksha Plan
Coverage scope: Reimbursement for medical expenses incurred for in-patient treatment up to 7.5% of the sum insured
- Star Health
Plan name: Medi Classic Insurance Policy
Coverage scope: Coverage up to 25% of the sum insured, subject to Rs 25,000 per policy period.
- Tata AIG
Plan name: MediPrime
Coverage scope: Reimbursement for in-patient treatment up to a maximum amount of Rs 25,000.
- New India Assurance
Plan name: Mediclaim Policy
Coverage scope: Coverage of up to 25% of the sum insured.
Here are some questions typically asked regarding insurance cover for AYUSH:
1. What kind of coverage can I expect under AYUSH treatment?
You can expect reimbursement for treatment expenses up to the specified limit of the sum insured – the cap ranges from 7% to 25% on the amount covered. Some insurers fix a standard amount as a sublimit.
2. Do insurers offer cashless facility under AYUSH treatment?
Very few insurers offer cashless treatment facility; you are advised to check with the insurer before buying a plan. Usually, the claim amount is reimbursed after the requisite documents are submitted.
3. Will AYUSH treatment in any hospital be eligible for reimbursement?
The treatment has to be undertaken in a government hospital accredited by the Quality Council of India or NABH for your claim to be honoured under your health plan.
4. I need AYUSH in addition to regular allopathic treatment for my ailment. Can I claim reimbursement for both?
Once a claim for a specified disease has been made for allopathic treatment, you cannot claim reimbursement for a non-allopathic form of treatment (AYUSH) for the same disease under the same plan during the policy period, and vice versa.
5. Why do I need AYUSH treatment?
Some people, especially those above 60, respond to AYUSH better than other forms of treatment.
6. Are there any limitations of AYUSH treatment?
There are two. First, only a few hospitals provide AYUSH treatment, which limits your options. Second, health plans cover benefits for in-patient hospitalisation of at least 24 hours, whereas AYUSH therapies are mostly done by outpatient departments.